Provider Demographics
NPI:1326594771
Name:PREMIUM HOME SERVICES LLC
Entity Type:Organization
Organization Name:PREMIUM HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-451-1465
Mailing Address - Street 1:14140 UNION TPKE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3654
Mailing Address - Country:US
Mailing Address - Phone:516-451-1465
Mailing Address - Fax:718-907-3722
Practice Address - Street 1:2850 SHORE PKWY
Practice Address - Street 2:APT 2R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6756
Practice Address - Country:US
Practice Address - Phone:718-812-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2299L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health